Provider Demographics
NPI:1295721785
Name:NOWELL, DAWN M (FNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:NOWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:563-210-0873
Mailing Address - Fax:
Practice Address - Street 1:5683 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5531
Practice Address - Country:US
Practice Address - Phone:563-210-0873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003892363LF0000X
IAA083201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL309001343OtherCONTROLLED SUBSTANCE #
IA421060724A7OtherJOHN DEERE HEALTH
IA02266OtherIA BCBS SEEN IN DAVENPORT
IL235624OtherMIDLAND'S CHOICE
P42667OtherUPIN
078004OtherHEALTH ALLIANCE
IA5201205OtherCONTROLLED SUBSTANCE#
IA93109OtherIA BCBS SEEN IN RI
IA93082OtherIA BCBS SEEN IN MOLINE
IAIA01A7OtherJOHN DEERE EDI#
IA421060724OtherBILLING TAX ID# FOR CHC
IA421060724OtherBILLING TAX ID# FOR CHC
IA161801Medicare ID - Type UnspecifiedMEDICARE UGS
IA02266OtherIA BCBS SEEN IN DAVENPORT
MN0807389OtherFEDERAL DEA#